With the advent of warmer weather, patients with stinging insect sensitivity must be more alert, and physicians may need to be more aware of the latest guidelines for treatment. Dr. Susann Kircher, Allergy & Asthma Center of Birmingham, has served on the Insect Hypersensitivity Committee of the American College of Allergy, Asthma and Immunology for three years now. The committee provides recommendations to the association's board of regents and monitors and implements programs in the area of insect allergies and hypersensitivity. Kircher says that allergy shots for stinging insects are particularly effective. "Usually I strongly recommend it; patients can be 97 percent cured for venom anaphylaxis. It's one of the few times I'll actually say I think we should do allergy shots." There are exceptions. Most children with these allergies will outgrow them by the age of 16, she explains. "If you are under 16 and it is just a cutaneous reaction, most of the literature supports that you will outgrow it, if it was not a life-threatening reaction. Then you can make a case to prescribe the child an EpiPen® and talk about avoidance measures and not actually give them allergy shots." But with younger children who have a life-threatening reaction or those over 16 who continue to show signs of sensitivity, immunotherapy may be called for. As with any series of allergy shots, immunotherapy is a long-term time commitment. "The schedule for getting on a therapeutic dose of the venom is a lot faster than general shots," says Kircher. "We usually can get people to a good level of the shots faster than with most inhalant allergens. Usually we can get you up to maintenance in a couple of months. They recommend three to five years on the venom shots, and most people are now leaning toward five years. A lot of times we'll retest at the end of that time to see if they're still allergic." The long term commitment generally pays off. "They think you're protected for life. Now, if someone has an allergic systemic reaction while they're getting allergy shots, or if we retest and their sensitivity has not really gone down, or they had a near-fatal reaction to the venom initially, or if they get stung while they are in immunotherapy and they still have a reaction, those people may have to continue on the shots lifelong." Patients may come in believing they know what they are allergic to, but testing is still important. "History can be very misleading," says Kircher. "You don't want to commit someone to a lot of shots and something that potentially can be dangerous unless you know for sure what you are dealing with. You want to make sure you aren't missing something or treating for the wrong thing. When it comes to the stinging insects, they all look the same. We test for all the flying, stinging insects and make sure we're going to get all of them, because you don't want to undertreat as well." For those patients who are sensitive to stinging insects, Kircher offers these reminders: "If you are going to be outdoors, stay away from trash cans and open soda can containers. Do not wear bright clothing – it attracts them. Don't wear perfumes; that also will attract. Wear long sleeves and long pants. And no sandals."